Dyspareunia is a medical term that is used to describe painful sexual intercourse. The condition can be defined as genital pain that occurs just before, during or after sex, and that can be caused by a plethora of medical, biological, interpersonal, psychological and socio-cultural factors.
This clinical entity can be further divided into primary dyspareunia (always occurring in association with sexual activity) and secondary dyspareunia (arising after a certain period of pain-free sexual intercourses). It can also be divided into superficial (or entry) dyspareunia and deep dyspareunia that is more commonly linked to organic pathology.
However, these subdivisions are over-simplistic and rarely clinically applicable, which is often the case with various painful medical issues. Moreover, dyspareunia is a type of problem that prompts specific patient behavior where several clinicians are typically consulted in an effort to appraise and treat the problem.
This condition has been associated with a negative attitude toward sexuality, as well as with lower levels of relationship adjustment. Thus, it is not surprising that patients with dyspareunia exhibit lower frequency of sexual intercourse and lower levels of arousal and desire.
Epidemiology of Dyspareunia
Although dyspareunia may appear in both women and men, in the latter group it is relatively rare. Conversely, in women this is a highly prevalent condition that occurs in more than 40% of women, predominantly among those that belong to younger age groups. Dyspareunia has also been identified as one of the most common sexual complaints that women spontaneously report to their gynecologists.
When assessing general prevalence of sexual dysfunctionality in the US women, those presenting with dyspareunia comprised only a small fraction in comparison to women with arousal difficulties, orgasmic difficulties and decreased interest for sexual activities. The prevalence of the condition in this specific sample was only seven percent.
However, a study that looked primary care practices found dyspareunia in 46% of sexually active women (with the definition including pain during or after sexual intercourse). Moreover, postpartum dyspareunia was observed in 45% of women in a study from the US.
If dyspareunia is broadly defined as episodic pain during sexual intercourse, the percentage of affected women climbs up to 60%. However, women that have such severe symptoms that they actually seek medical attention are part of a much smaller group (which is why the condition is not always recognized).
How to Approach a Patient with Dyspareunia
In order to properly address the patient’s concerns about dyspareunia and painful experiences during sex, attending health care providers have to approach the issue of sexuality carefully and entirely. That is the only way to create opportunities for their patients to freely reveal what bothers them.
Physicians may even be comfortable about instigating sexual inquiry, but they can still put too much emphasis on the potential biological basis of their problem, thereby unintentionally neglecting the interpersonal, psychological and cultural determinants of dyspareunia. Organic causes are sometimes the sole culprit, but psychological factors always have to be taken into account.
Therefore, different sexual-counseling strategies are at the disposal of the health-care providers to assess and decide on the best treatment approach for dyspareunia. One example is the PLISSIT model that consists of four counseling levels, but other patient-centered models to understand patient experiences are also commonly used.
A recent move toward multidisciplinary approach represents a positive step forward – not only in establishing an early diagnosis of this condition, but also to acknowledge potential secondary consequences of the pain that must be managed in order to facilitate a complete recovery.
Reviewed by Afsaneh Khetrapal Bsc (Hons)
- Dor K. Dyspareunia. In: O’Connell TX, Dor K. Instant Work-Ups: A Clinical Guide to Obstetric and Gynecologic Care. Elsevier Health Sciences, 2009; pp. 66-70.
- Vincent K, Moore J. Pelvic Pain in Females. In: Fishman S, Ballantyne J, Rathmell JP, editors. Bonica’s Management of Pain. Lippincott Williams & Wilkins, 2010; pp. 925-940.